| NPI | 1124059340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL OSOOO6606) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL OS0006606) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2019-10-02 |